title: Comparison of associations of outcomes after stroke with estimated GFR using Chinese modifications of the MDRD study and CKD-EPI creatinine equations: results from the China National Stroke Registry.
abstract: BACKGROUND
  The CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation estimates glomerular filtration rate (GFR) more precisely than the MDRD (Modification of Diet in Renal Disease) Study equation. The risk implications of this equation have been compared with the MDRD Study equation in different demographic and clinical characteristics. However, whether a Chinese modification of this equation performs better than a Chinese modification of the MDRD Study equation in risk prediction in Chinese patients with stroke is unknown.
  
  
  METHODS
  Prospective cohort study, China National Stroke Registry.
  
  
  METHODS
  15,791 consecutive patients with stroke enrolled from September 2007 to August 2008; follow-up time, 1 year.
  
  
  METHODS
  Estimated GFR (eGFR) and eGFR categories computed using Chinese modifications of the MDRD Study and CKD-EPI creatinine equations.
  
  
  RESULTS
  All-cause mortality, recurrent stroke, stroke disability, combined end point of stroke or death.
  
  
  METHODS
  GFR was estimated by Chinese modifications of the MDRD Study (eGFRMDRD(CN)) and CKD-EPI (eGFRCKD-EPI(CN)) equations.
  
  
  RESULTS
  The median value for eGFRCKD-EPI(CN) was higher than that for eGFRMDRD(CN) (87.3 vs 82.5 mL/min/1.73 m(2); P<0.001). 22.8% of patients were reclassified by the CKD-EPI China equation (11.5% [1,818/15,791] to a higher eGFR category, and 11.3% [1,789/15,791], to a lower eGFR category). Of patients with eGFRMDRD(CN) of 60-89 and 30-59 mL/min/1.73 m(2), 18.3% (1,299/7,090) and 18.4% (422/2,296) were reclassified upward to a higher eGFR category, respectively, reducing the CKD prevalence from 16.4% to 14.2%. Net reclassification improvement favored the Chinese modification of the CKD-EPI equation for the prediction of all-cause mortality, stroke recurrence, death, or stroke recurrence and stroke disability (net reclassification improvements of 0.05, 0.03, 0.04, and 0.1, respectively; all P<0.01).
  
  
  CONCLUSIONS
  Relatively short follow-up time and no measurement of albuminuria.
  
  
  CONCLUSIONS
  Our findings suggest that a Chinese modification of the CKD-EPI equation may improve risk prediction of all-cause mortality, stroke recurrence, death or stroke recurrence and stroke disability more than a Chinese modification of the MDRD Study equation in Chinese stroke patients.
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Xianwei
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Yilong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Chunxue
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Xingquan
authors.initials: X
authors.lastname: Zhao
authors.affiliation: INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria, IL.
authors.forename: David
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Liping
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Gaifen
authors.initials: G
authors.lastname: Liu
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. Electronic address: yongjunwang1962@gmail.com.
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000368:Aged; D002681:China / Q000453:epidemiology; D003404:Creatinine / Q000097:blood*; D004185:Disability Evaluation; D023381:Endpoint Determination; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D051437:Renal Insufficiency / Q000097:blood / Q000150:complications / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D016019:Survival Analysis
chemical_list: D003404:Creatinine
keywords: Estimated glomerular filtration rate; epidemiology; outcome; stroke